SW3150202_Supplemental Info Review_20190125

Submittal Dated: 1/25/2019
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are answered.
Existing Project Information:
Rease supply the perrrit nunber for this project.
D# * FL-rrrit Narrber
SW3150202
Examples: SWxxxxxxx, NO&xxxxx, or NOSxxxxxx
Facility Name:* Amber Meadow
County: Union
Name: Samantha Martinez
Who is submitting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
Qick the upload button or drag and drop files here to attach docurrant
_Combined As -Built Report 2019-01-24.pdf 6.99MB
_SIGNED Amber Meadows - Pond Asbuilt.pdf 7.7MB
Only pdf files are accepted.
Describe the attachments:
Enclosed are routing computations based off the as -built survey that is also attached.
* W By checking the box and signing box below, I certify that:
• I have given true, accurate, and complete information on this form;
• I agree that submission of this Supplemental Information form is a "transaction" subject to Chapter 66, Article 40 of
the NC General Statutes (the "Uniform Electronic Transactions Act)
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act');
o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the Supplemental Information form."
Full Name:* Samantha Martinez
Signature:
Jaw& 4��

Date Submitted: 1/25/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW3150202
Who needs a V Central Office
copy?* F Regional Office
Central Office Reviewer:
Rick Riddle - eads\rlriddle1
Select Reviewing Office*
Mooresville Regional Office — 704-663-1699
Select RO Reviewer:*
[e-mail]